Copyright @ 200 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited. 7 Technical Experiences Reconstruction of Traumatic Orbital Floor Fractures With Resorbable Mesh Plate Serhan Tuncer, MD, Reha Yavuzer, MD, Sebahattin Kandal, MD, Yucel H. Demir, MD, Selahattin Ozmen, MD, Osman Latifoglu, MD, Kenan Atabay, MD Ankara, Turkey Various materials such as autogenous bone, carti- lage and alloplastic implants have been used to reconstruct orbital floor fractures. A new material is needed because of disadvantages of nonresorbable alloplastic materials and difficulties in harvesting autogenous tissues. In this study safety and value of the use of resorbable mesh plate in the treatment of orbital floor fractures are discussed. Between 2002 and 2004 a total of 17 maxillofacial trauma patients complicated with orbital floor fractures were treated with resorbable mesh plate through subciliary or transconjunctival incisions. Pure blow-out fractures were determined in 6 patients and 11 patients had accompanying maxillofacial fractures. Resorbable plate was easily shaped to fit to the orbital floor by cutting with scissors. Patients were evaluated clinically and with computed tomog- raphy scans preoperatively and at 3-, 6- and 12- month intervals postoperatively. Twelve patients had preoperative enophthalmos. Two patients had diplopia that was corrected postoperatively. In all 17 cases there was no evidence of infection, diplopia and gaze restriction postoperatively. Scleral show appeared in three patients by the second post- operative week but resolved totally within 3 to 6 weeks except one patient. In this patient anterior displacement of mesh was evident which caused ectropion and enophthalmos and required re- operation. No any other mesh related problems were seen at 15 months mean follow-up time. The advantage of the resorbable mesh system in orbital floor fracture is the maintenance of orbital contents against herniation forces during the initial phase of healing and then complete resorption through natural processes after its support is no longer needed. Our experience represents that resorbable mesh is a safe and effective material for reconstruc- tion of the selected, non-extensive orbital floor fractures. Key Words: Ortbital floor fracture, resorbable plate, diplopia B lunt periorbital trauma or more often frac- tures of the upper part of the face particu- larly, the zygomatico-orbital complex, impair the three-dimensional (3-D) struc- ture of the bony orbit at the weakest vulnerable areas especially in the orbital floor. 1,2 Orbital floor frac- tures present with varying degree of severity and extension. However, even simple, isolated orbital blow-out fractures may cause functional and cos- metic problems like residual dystopia, diplopia and enophthalmos due to herniation of the orbital soft tissue content into the maxillary sinus together with extraocular muscle entrapment between bony fragments. 3 Two mechanisms are accepted to be the cause of the orbital floor fractures. In the buckling mechanism it is suggested that traumatic force is transmitted by bony conduction through the orbital rim to the orbital floor while in the hydraulic mechanism, elevated hydrostatic pressure inside the orbital cavity causes a disruption of the orbital floor which is known to be the weakest region. 4 Clinical findings of the orbital floor fractures include periorbital bruising and edema, limitation of the vertical and horizontal ocular movements which cause diplopia, enophthalmos and in some cases decreased sensation in the distribution of the infraorbital nerve. A characteristic ‘teardrop’ appearance can be seen in the maxillary antrum at conventional X-rays but blood inside the maxillary sinus may mask this diagnostic sign. In the diagnosis of blow-out frac- tures and any orbital volume change which might cause enophthalmos, computed tomography (CT) is the most accepted tool. Axial and coronal CT scans not only provide the data of the location and size of the fracture but also can be used for improved surgical planning. 5 598 From the Gazi University Faculty of Medicine, Plastic, Recon- structive and Aesthetic Surgery Department, Ankara, Turkey. Address correspondence and reprint requests to Reha Yavuzer, MD, BarNz Sitesi 87. Sokak No:24, 06530 M. Kemal Mah., Ankara, Turkey; E-mail: ryavuzer@hotmail.com